CDC Considers Recommending Routine HIV Tests

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The Centers for Disease Control and Prevention may soon recommend that family physicians make HIV testing part of a routine check-up.

FARAI CHIDEYA, host:

I'm Farai Chideya, and this is NEWS AND NOTES.

Federal health officials may soon recommend that family physicians make HIV testing a part of every routine checkup. The Centers for Disease Control and Prevention is circulating draft guidelines that would recommend that everyone in the U.S. from 13 to 64 years old be screened for the virus.

The guidelines reflect that new populations are now at highest risk for the virus, including African-Americans.

Sarah Varney reports.

SARAH VARNEY reporting:

The CDC estimates about a quarter of the one million Americans infected with HIV don't know it. And that group is most responsible for spreading the virus.

Federal officials say by making HIV screening routine, physicians can detect infection earlier, get patients started on life-saving medication and contain the epidemic.

Ms. JENNIFER CATES (Director of HIV Policy, Kaiser Family Foundation): There's a feeling that we're missing people. We're missing an opportunity to screen people for HIV in healthcare settings because doctors are not asking people if they want to get tested or people are not asking to be tested.

VARNEY: Jennifer Cates is director of HIV policy at the Kaiser Family Foundation, a nonprofit research organization in Washington, D.C.

Ms. CATES: So the idea behind this new shift is to make it much more a part of what people experience when they go to a healthcare provider like they experience with other kinds of tests.

VARNEY: That's a big change from how HIV testing is currently done. But over the last quarter century, America's AIDS epidemic has reached into new populations and physicians can no longer rely on traditional risk factors. Heterosexuals, teenagers and minorities are at far greater risk of infection. In fact, though African-Americans are about 13 percent of the U.S. population, they now make up half of all new infections.

The CDC's draft recommendations include other sweeping changes. For example, they eliminate requirements for written consent and pre-test counseling. AIDS patient advocates say making HIV testing a normal part of healthcare will ease the stigma still associated with the disease, but they question whether overtaxed primary care physicians are equipped to deal with HIV testing.

Dr. Carla Kakutani is a family doctor in rural Winters, west of Sacramento, and the president-elect of the California Academy of Family Physicians. Dr. Kakutani says insurance companies don't pay doctors to counsel patients.

Dr. CARLA KAKUTANI (President-Elect, California Academy of Family Physicians): A lot of that stuff is done on the primary care physician's tab. Particularly if you're in a solo practice, you, you know, have a lot of overhead to cover, that's time spent that, you know, doesn't bring any money to cover your overhead.

VARNEY: The CDC's recommendations are voluntary, but state health departments, doctors and especially insurers look at them closely. Testing all Americans age 13 to 64 would cost health insurance companies hundreds of millions of dollars. And private insurers may decide near-universal testing is not worth the price tag.

Jeff Sheehy, San Francisco's mayoral adviser on AIDS, isn't convinced it's a good investment either. Sheehy doubts that universal testing will help identify the 25 percent of people who are unknowingly infected.

Mr. JEFF SHEEHY (HIV/AIDS Policy Adviser, San Francisco Mayor's Office): It only really works if people are seeing a healthcare provider. And if you look at the populations that are most are at risk for HIV, they tend to be folks who don't have the best access to the healthcare system. Youth, people of color, low-income folks, urban poor...

VARNEY: And in California, undocumented workers without insurance. But perhaps the biggest question raised by the proposed guidelines is who will pay for treatment if those HIV cases are identified.

AIDS Project Los Angeles Executive Director Craig Thompson:

Mr. CRAIG THOMPSON (Executive Director, AIDS Project Los Angeles): Hypothetically, let's say that we suddenly were able to identify across the country 250,000 more people with HIV. We do not have the resources in Los Angeles and San Francisco and New York, and certainly not in South Carolina, to treat those 250,000 people.

VARNEY: Many U.S. cities have long waiting lists for government-funded treatment. And on those lists are people who want to buy individual health insurance plans but can't because, with few exceptions, private health insurance companies will not insure them.

The CDC's final recommendations on HIV testing are expected to be approved in September.

For NPR News, I'm Sarah Varney.

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